Highlights & Basics
- Colonic angiodysplasia is a degenerative vascular malformation of the gastrointestinal tract characterized by fragile and leaky blood vessels.
- Second most common cause of lower gastrointestinal bleeding in patients >60 years of age.
- Lesions may be single or multiple and are located most commonly in the ascending colon and cecum.
- Bleeding stops spontaneously in >90% of patients.
- Patients often complain of intermittent gastrointestinal bleeding without pain.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Ileocolic artery on mesenteric angiogram. Vascular tufts and tangles from local mass of irregular vessels displayed
Ileocolic artery on mesenteric angiogram
Mesenteric angiogram. Early and intensely filling vein resulting from direct arteriovenous communication
Mesenteric angiogram. Persistent opacification beyond normal venous phase
Mesenteric angiogram. Persistent opacification beyond normal venous phase
Endoscopic image of argon plasma coagulation of colonic angiodysplasia
Citations
Lieberman D. Gastrointestinal bleeding: initial management. Gastroenterol Clin North Am. 1993 Dec;22(4):723-36.[Abstract]
Leitman IM, Paull DE, Shires GT III. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. 1989 Feb;209(2):175-80.[Abstract][Full Text]
1. Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol. 1993 Jun;88(6):807-18.[Abstract]
2. Annamalai G, Robertson I. Acute gastrointestinal haemorrhage: investigation and treatment. Imaging. 2004;16:264-70.
3. Foutch PG, Rex DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol. 1995 Apr;90(4):564-7.[Abstract]
4. Baer JW, Ryan S: Analysis of cecal vasculature in the search for vascular malformations. AJR Am J Roentgenol. 1976 Feb;126(2):394-405.[Abstract][Full Text]
5. Clouse RE, Costigan DJ, Mills BA, et al. Angiodysplasia as a cause of upper gastrointestinal bleeding. Arch Intern Med. 1985 Mar;145(3):458-61.[Abstract][Full Text]
6. Wandono H. Diagnosis and treatment of hematochezia: guideline for clinical practice. Acta Med Indones. 2007 Oct-Dec;39(4):202-6.[Abstract][Full Text]
7. Tsai TJ, Chen WC, Huang YT, et al. Hemodialysis increases the risk of lower gastrointestinal bleeding and angiodysplasia bleeding: A nationwide population study. Gastroenterol Res Pract. 2020;2020:7206171.[Abstract][Full Text]
8. Zajjari Y, Tamzaourte M, Montasser D, et al. Gastrointestinal bleeding due to angiodysplasia in patients on hemodialysis: A single-center study. Saudi J Kidney Dis Transpl. 2016 Jul-Aug;27(4):748-51.[Abstract][Full Text]
9. Bush RW, Huff JW. Von Willebrand's disease and severe gastrointestinal bleeding: report of a kindred. West J Med. 1984 May;140(5):781-3.[Abstract][Full Text]
10. Franchini M, Mannucci PM. Gastrointestinal angiodysplasia and bleeding in von Willebrand disease. Thromb Haemost. 2014 Sep 2;112(3):427-31.[Abstract][Full Text]
11. Imperiale TF, Ransohoff DF. Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: is there an association? A methodologic critique of the literature. Gastroenterology. 1988 Dec;95(6):1670-6.[Abstract]
12. Morishima A, Marui A, Shimamoto T, et al. Successful aortic valve replacement for Heyde syndrome with confirmed hematologic recovery. Ann Thorac Surg. 2007 Jan;83(1):287-8.[Abstract]
13. Pate GE, Mulligan A. An epidemiological study of Heyde's syndrome: an association between aortic stenosis and gastrointestinal bleeding. J Heart Valve Dis. 2004 Sep;13(5):713-6.[Abstract][Full Text]
14. Marie I, Antonietti M, Houivet E, et al. Gastrointestinal mucosal abnormalities using videocapsule endoscopy in systemic sclerosis. Aliment Pharmacol Ther. 2014 Jul;40(2):189-99.[Abstract][Full Text]
15. Grooteman KV, Holleran G, Matheeuwsen M, et al. A risk assessment of factors for the presence of angiodysplasias during endoscopy and factors contributing to symptomatic bleeding and rebleeds. Dig Dis Sci. 2019 Oct;64(10):2923-32.[Abstract][Full Text]
16. Holleran G, Hall B, Hussey M, et al. Small bowel angiodysplasia and novel disease associations: a cohort study. Scand J Gastroenterol. 2013 Apr;48(4):433-8.[Abstract][Full Text]
17. Nishimura N, Mizuno M, Shimodate Y, et al. Risk factors for active bleeding from colonic angiodysplasia confirmed by colonoscopic observation. Int J Colorectal Dis. 2016 Dec;31(12):1869-73.[Abstract][Full Text]
18. Diggs NG, Holub JL, Lieberman DA, et al. Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study. Clin Gastroenterol Hepatol. 2011 May;9(5):415-20; quiz e49.[Abstract][Full Text]
19. Athanasoulis CA, Galdabini JJ, Waltman AC, et al. Angiodysplasia of the colon: a cause of rectal bleeding. Cardiovasc Radiol. 1977-1978;1:3-13.[Abstract]
20. Baum S, Athanasoulis CA, Waltman AC, et al. Angiodysplasia of the right colon: a cause of gastrointestinal bleeding. AJR Am J Roentgenol. 1977;129:789-94.[Abstract][Full Text]
21. Vincentelli A, Susen S, Le Tourneau T, et al. Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med. 2003 Jul 24;349(4):343-9.[Abstract][Full Text]
22. Fressinaud E, Meyer D. International survey of patients with von Willebrand disease and angiodysplasia. Thromb Haemost. 1993 Sep 1;70(3):546.[Abstract]
23. Sengupta N, Feuerstein JD, Jairath V, et al. Management of patients with acute lower gastrointestinal bleeding: an updated ACG guideline. Am J Gastroenterol. 2023 Feb 1;118(2):208-31.[Abstract][Full Text]
24. Oakland K, Jairath V, Uberoi R, et al. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. Lancet Gastroenterol Hepatol. 2017 Sep;2(9):635-43.[Abstract]
25. Oakland K, Kothiwale S, Forehand T, et al. External validation of the Oakland Score to assess safe hospital discharge among adult patients with acute lower gastrointestinal bleeding in the US. JAMA Netw Open. 2020 Jul 1;3(7):e209630.[Abstract][Full Text]
26. Brandt LJ, Spinnell MK. Ability of naloxone to enhance the colonoscopic appearance of normal colon vasculature and colon vascular ectasias. Gastrointest Endosc. 1999 Jan;49(1):79-83.[Abstract]
27. Raju GS, Gerson L, Das A, et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology. 2007 Nov;133(5):1697-717.[Abstract][Full Text]
28. Leenhardt R, Li C, Koulaouzidis A, et al. Nomenclature and semantic description of vascular lesions in small bowel capsule endoscopy: an international Delphi consensus statement. Endosc Int Open. 2019 Mar;7(3):E372-9.[Abstract][Full Text]
29. Ettorre GC, Francioso G, Garribba AP, et al. Helical CT angiography in gastrointestinal bleeding of obscure origin. AJR Am J Roentgenol. 1997 Mar;168(3):727-31.[Abstract][Full Text]
30. Junquera F, Quiroga S, Saperas E, et al. Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology. 2000 Aug;119(2):293-9.[Abstract]
31. Chuang FJ, Lin JS, Yeung CY, et al. Intestinal angiodysplasia: an uncommon cause of gastrointestinal bleeding in children. Pediatr Neonatol. 2011 Aug;52(4):214-8.[Abstract][Full Text]
32. Lieberman D. Gastrointestinal bleeding: initial management. Gastroenterol Clin North Am. 1993 Dec;22(4):723-36.[Abstract]
33. Jensen DM, Machiado GA. Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge. Gastroenterology. 1988 Dec;95(6):1569-74.[Abstract]
34. Lefkovitz Z, Cappell MS, Kaplan M, et al. Radiology in the diagnosis and therapy of gastrointestinal bleeding. Gastroenterology Clin North Am. 2000 Jun;29(2):489-512.[Abstract]
35. Kadir S. Diagnostic angiography. Philadelphia, PA: WB Saunders; 1986:361.
36. Leitman IM, Paull DE, Shires GT III. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. 1989 Feb;209(2):175-80.[Abstract][Full Text]
37. Nath RL, Sequeira JC, Weitzman AF, et al. Lower gastrointestinal bleeding: diagnostic approach and management conclusions. Am J Surg. 1981 Apr;141(4):478-81.[Abstract]
38. Whitaker SC, Gregson RH. The role of angiography in the investigation of acute or chronic gastrointestinal haemorrhage. Clin Radiol. 1993 Jun;47(6):382-8.[Abstract]
39. Zuckerman DA, Bocchini TP, Birnbaum EH. Massive hemorrhage in the lower gastrointestinal tract in adults: diagnostic imaging and intervention. AJR Am J Roentgenol. 1993 Oct;161(4):703-11.[Abstract][Full Text]
40. Gupta H, Luna E, Kingsley S, et al. Detection of gastrointestinal bleeding by radionuclide scintigraphy. Am J Gastroenterol. 1984 Jan;79(1):26-31.[Abstract]
41. Bentley DE, Richardson JD. The role of tagged red blood cell imaging in the localization of gastrointestinal bleeding. Arch Surg. 1991 Jul;126(7):821-4.[Abstract]
42. Bunker SR, Lull RJ, Tenasescu DR, et al. Scintigraphy of gastrointestinal hemorrhage: superiority of 99mTc red blood cells over 99mTc sulphur colloid. AJR Am J Roentgenol. 1984 Sep;143(3):543-8.[Abstract][Full Text]
43. Bunker SR, Brown JM, McAuley RJ, et al. Detection of gastrointestinal bleeding sites: use of in vitro technetium Tc99m-labeled RBCs. JAMA. 1982 Feb 12;247(6):789-92.[Abstract]
44. Hindryckx P, Botelberge T, De Vos M, et al. Clinical impact of capsule endoscopy on further strategy and long-term clinical outcome in patients with obscure bleeding. Gastrointest Endosc. 2008 Jul;68(1):98-104.[Abstract]
45. Hanna RF, Browne WF, Khanna LG, et al. Gadofosveset trisodium-enhanced MR angiography for detection of lower gastrointestinal bleeding. Clin Imaging. 2015 Nov-Dec;39(6):1052-5.[Abstract][Full Text]
46. Sami SS, Al-Araji SA, Ragunath K. Review article: gastrointestinal angiodysplasia - pathogenesis, diagnosis and management. Aliment Pharmacol Ther. 2014 Jan;39(1):15-34.[Abstract][Full Text]
47. ASGE Standards of Practice Committee, Coelho-Prabhu N, Forbes N, et al. Adverse events associated with EGD and EGD-related techniques. Gastrointest Endosc. 2022 Sep;96(3):389-401.e1.[Abstract][Full Text]
48. Storm AC, Fishman DS, Buxbaum JL, et al. American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures. Gastrointest Endosc. 2022 Feb;95(2):207-15.[Abstract][Full Text]
49. Olmos JA, Marcolongo M, Pogorelsky V, et al. Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia. Dis Colon Rectum. 2006 Oct;49(10):1507-16.[Abstract][Full Text]
50. Olmos JA, Marcolongo M, Pogorelsky V, et al. Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias. Gastrointest Endosc. 2004 Dec;60(6):881-6.[Abstract][Full Text]
51. Pichon Riviere A, Augustovski F, Garcia Marti S, et al. Argon plasma usefulness for the treatment of gastrointestinal lesions. Buenos Aires, Argentina: Ciudad de Buenos Aires, Institute for Clinical Effectiveness and Health Policy (IECS); 2005.
52. Karuppasamy K, Kapoor BS, Fidelman N, et al. Expert panel on interventional radiology, ACR appropriateness criteria® radiologic management of lower gastrointestinal tract bleeding: 2021 Update. J. Am. Coll. Radiol. 2021 May 21;18(5):S139-52.[Abstract][Full Text]
53. Brown C, Subramanian V, Wilcox CM, et al. Somatostatin analogues in the treatment of recurrent bleeding from gastrointestinal vascular malformations: an overview and systematic review of prospective observational studies. Dig Dis Sci. 2010 Aug;55(8):2129-34.[Abstract]
54. Swanson E, Mahgoub A, MacDonald R, et al. Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia: a systematic review. Clin Gastroenterol Hepatol. 2014 Apr;12(4):571-82.[Abstract][Full Text]
55. Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol. 2014 Apr;109(4):474-83.[Abstract][Full Text]
56. Goltstein LCMJ, Grooteman KV, Rocco A, et al. Effectiveness and predictors of response to somatostatin analogues in patients with gastrointestinal angiodysplasias: a systematic review and individual patient data meta-analysis. Lancet Gastroenterol Hepatol. 2021 Nov;6(11):922-32.[Abstract][Full Text]
57. Arieira C, Magalhães R, Dias de Castro F, et al. Small bowel angioectasias rebleeding and the identification of higher risk patients. Dig Dis Sci. 2021 Jan;66(1):175-80.[Abstract][Full Text]
58. Suh SW, Choi YS, Kim H, et al. Small bowel ischemia after angiographic embolization for angiodysplasia of lower gastrointestinal tract: the case for conservative management. Clin Res Hepatol Gastroenterol. 2011 Dec;35(12):819-22.[Abstract][Full Text]
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